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Leadership of healthcare commissioning networks in England : a mixed-methods study on clinical commissioning groups
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Zachariadis, Markos, Oborn, Eivor, Barrett, Michael I. and Zollinger-Read, Paul (2013) Leadership of healthcare commissioning networks in England : a mixed-methods study on clinical commissioning groups. BMJ Open, Volume 3 (Number 2). Article number e002112. doi:10.1136/bmjopen-2012-002112 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2012-002112
Abstract
Objective: To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation.
Design: Mixed-method, multisite and case study research.
Setting: Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population.
Methods: Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis.
Main outcome measures: Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs.
Results: Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders.
Conclusions: With the new commissioning arrangements, the leaders should seek to move away from dyadic and transactional relationships to a network structure, thereby emphasising on the emerging relational focus of their roles. Managing knowledge mobility, healthcare network coherence and network stability are the three clinical leadership processes that CCG leaders need to consider in coordinating their network and facilitating the development of good clinical commissioning decisions, best practices and innovative services. To successfully manage these processes, CCG leaders need to leverage the relational capabilities of their network as well as their clinical expertise to establish appropriate collaborations that may improve the healthcare services in England. Lack of local GP engagement adds uncertainty to the system and increases the risk of commissioning decisions being irrelevant and inefficient from patient and provider perspectives.
Item Type: | Journal Article | ||||
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Subjects: | H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management R Medicine > R Medicine (General) |
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Divisions: | Faculty of Social Sciences > Warwick Business School > Entrepreneurship, Innovation & Management Faculty of Social Sciences > Warwick Business School > Information Systems & Management Faculty of Social Sciences > Warwick Business School |
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Library of Congress Subject Headings (LCSH): | Leadership -- Great Britain, Great Britain. National Health Service, Medical personnel -- Great Britain | ||||
Journal or Publication Title: | BMJ Open | ||||
Publisher: | BMJ | ||||
ISSN: | 2044-6055 | ||||
Official Date: | 20 February 2013 | ||||
Dates: |
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Volume: | Volume 3 | ||||
Number: | Number 2 | ||||
Page Range: | Article number e002112 | ||||
DOI: | 10.1136/bmjopen-2012-002112 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Date of first compliant deposit: | 25 December 2015 | ||||
Date of first compliant Open Access: | 25 December 2015 | ||||
Funder: | Collaborations for Leadership in Applied Health Research and Care (CLAHRC), National Institute for Health Research (Great Britain) (NIHR) |
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